Weekly Update

As part of the professionalism curriculum, GME has asked that we complete the below modules and have a professionalism session in conference. The ACGME is coming to NYP in less than 2 weeks and professionalism has been identified as an area that all departments need to demonstrate proof.

We have a requirement for Residents to complete:

GME Professionalism modules (6)
Have attended or review the meeting above
Complete the Qualtrics link below

All of the following need to be completed by September 15th.

Here is the instruction for Requirement 1 above:

1. Graduate Staff (Residents, Fellows):

The professionalism module will be directly assigned to through your Workday profile. If you do not have access to Workday, please follow the Learning Center instructions provided below. To access the module, click on the link or copy and paste it into your browser (Google Chrome is recommended): https://www.myworkday.com/nyp/login.htmld.

2. If you attended the professionalism conference yesterday you are all set, if not, here are the links:

https://drive.google.com/file/d/1FZb5SZCQgW4JFAOAskKf6Csy7T5RDy_I/view?ts=6139110a

3. Here is the Qualtrics Attestation:

Here is a clickable link and the full URL is here:

https://docs.google.com/forms/d/e/1FAIpQLSeuxXMng6W-mBIJLxxA3VARzY00ZRPpogWdmTPkomLz10YVfw/viewform?usp=sf_link

I appreciate all the recent asks. Residents must complete by September 15th. Our PMs will follow up with reminders.

Thank you for all that you do,

Manish

From Dr. James Kenny: Admin Fellowship Opportunity

The Department of Emergency Medicine at the Hospital of the University of Pennsylvania is pleased to announce we are actively recruiting for a position in our EM Administrative Fellowship to start in the 2022 academic year. The Fellowship includes an MBA from the Wharton School at the University of Pennsylvania, and substantial financial support for that program. We encourage any interested applicants to review our website and to reach out to Dr. Keith Hemmert, Associate Fellowship Director.

From Kaush: Opportunity for writing book chapters

Let me know if you’re willing to write a book chapter. We have a 3 month deadline. Should be fairly easy to write. Few pages and few tables. Email me with your interest and I’ll send over the sample chapter.

Approach to Trauma
Approach to Wounds
Approach to Burns

Thanks,
Kaush

Campus Announcements

From our Columbia Critical Care Colleauges: Vitamin C and Sepsis

This week we review the recently hot but now lukewarm topic of vitamin C in sepsis. This trial compares HAT (hydrocortisone, ascorbic acid, thiamine) to thiamine in patients with septic shock. Note median tim to dose after ICU admission was 12 hours (in my mind that means 18-24 hours from initial sepsis presentation) Does any late therapy in sepsis work?

From Dr. Betty Chang: ICU sign out process, outpatient MRI workflow

Getting hold of our Care Managers / Social Workers:
Remember that the best way to reach the Care Coordination or Social Work team in real time is via the Secure Chat group below. The earlier they can be involved in a patient’s care, the better. Even if we don’t know the final disposition, they can help coordinate resources for the patient so that their stay is more efficient.
NEW: ED Primary Team to do hand-off to Primary ICU Team (effective: September 1st):
-In order to better serve our ICU level patients and improve our communication about the care of the patient, we will be doing a verbal hand-off from ED primary team to primary ICU Team starting September 1st. This is the similar process as regular floor admission process. PPOC will connect the two teams.
-If we need to contact the team, we can either chat them via “CUIMC MICU A (Admit Team)”, “CUIMC MICU B (Admit Team)”, etc. or call the ICUs directly.
-No change: ICU triage consult resident / attending will still do the patient allocation between ICU and SD, will help with management of ICU level patients in the ED, etc. ICU patients in the ED will still be the responsibility of ED primary team.
ED Boarding & Coverage:
-As many of you know, our volume is creeping up over the past few months (see below). Every day, the ED AOC works with MAC (medical admitting clinician) to get teams for the patients. We will continue to escalate to the Hospital senior leadership, and advocate for our patients.
I know it may not mean much, but just want to say “thank you” for doing the best you can under the current circumstances. Your hard work is truly appreciated. It has not been easy. I am hopeful that it will be better with overall staffing in the fall.

To end on a positive note, ED to Outpatient MRI process:
-We just hit the 50 patients mark (since go live in April) in getting our ED patients a non-emergent MRI (in lieu of admission or doing the MRI during an ED visit). Shout out to Eugene Kim for partnering with me on this initiative!
-Please keep in mind, that this is for ED patients; and Neurology needs to be involved so the MRI results are passed on to the appropriate people and not to ED providers.
-Please make sure you consult Patient Navigators for the PCP portion (Comment: Outpatient MRI). Neurology will arrange Neurology follow up and get the key stakeholders (call center, radiology, CM/SW, etc.) in a secure chat.

Reminders from the Cornell Opertions Leadership:

Escalation Rolodex:

Any clinically important delays can be escalated using the escalation rolodex
Search in nexus on top right “Escalation”
Use judiciously– involve your attending or admin attending if needed

LABS vs LWBS:

Only select Walked Out Before MSE if no providers have evaluated the patient, meaning there is no MSE Note, ED Provider Note, or ED Progress Note indicating evaluation.
If the patient has an MSE Note or other evaluation documented by any provider (it doesn’t have to be you!), choose Walked Out After MSE instead.
See Nexus > Dispo & Transfer > Elopement.

Reaching the Unit Coordinator (formerly PM):

For any equipment needs in the ED for which you need help, please utilize the epic role “WC GBG ED Unit Coordinator“ to reach the available UC, not the individual

Social Work/CC:

Please inform the patients that they often will need to wait substantial amounts of time for ambulette/lance and may need to pay for the ride
Refrain from offering ambulette/lance if the patient has the means to get home safely on their own

Patient navigators:

Reserve for patients who actually require services (who will fall through cracks if not given appointment)

Activations:

4 Activations: OB (include out of hospital deliveries), Trauma, Stroke, Acute MI/STEMI
Inform the unit clerk

Message from Dr. Peter Steele on ED Walk-Outs:

Our LWBS (left without being seen) rate has sky rocketed. This is a highly-scrutinized QPS metric by executive leadership; our individual chart reviews reveal many of these cases are due to inaccurate disposition documentation.

It is critical the ED team accurately documents left after being seen vs left without being seen. Please can you ensure the attached document is reviewed in detail by residents, specifically that LWBS should not be the selected disposition if there is any initiation of care prior to the event, including an APP triage RME.

If the patient walks out while an ED team member is performing an initial evaluation, please document that evaluation as a brief note and identify as pt as left after being seen.